Groin and Thigh

Groin pain

Groin pain in athletes is a common problem: it occurs in soccer in 5–13% of injuries in men and in 4–5% of injuries in women. It is one of the most difficult problems in sports medicine. A groin injury may be acute but if often leads to chronic pain with diffuse symptoms that are difficult to characterize, and these injuries are therefore often difficult to locate and to diagnose. Successful management, however, depends on correct diagnosis. The examining physician, physical therapist, or trainer must have a thorough knowledge of the differential diagnostic possibilities in the groin area. Teamwork is often necessary for a successful outcome: ideally this team should include not only an orthopedic surgeon and a primary physician, but also an experienced radiologist, a general surgeon, a gynecologist, and a neurologist. An experienced trainer and physical therapist should also be included.

The most common location for groin pain is the adductor muscle-tendon region, and the pain is usually caused by overuse injuries involving the adductor longus muscle-tendon junction. These injuries occur mostly in soccer and ice hockey, but are also seen in many other sports. Another common cause of groin pain is a hernia. In athletes with diffuse groin pain which is difficult to diagnose, the doctor should reasonably suspect a hernia. Hernia-related pain usually is centered on the inguinal region and spreads laterally along the inguinal ligament proximally in the muscles and to the opposite side. This pain can cause remarkable chronic discomfort. Radicular pain occurs in about 30%. These patients should be examined by a general surgeon. Herniography has shown to be successful in diagnosing intra-abdominal hernias. The syndrome of posterior inguinal wall weakness without a clinically obvious hernia causing chronic pain is increasingly recognized by practitioners. Other reasons for groin pain are osteitis pubis, hip pain of different etiologies, bursitis, snapping hip, nerve compression injuries, stress fractures, infections such as prostatitis and urinary infections, and tumors.

Information about chronic groin pain problems is still limited and mostly based on clinical experience. Groin injuries may in themselves not be serious. They may, however, lead to chronic pain and impair athletic ability and performance, if not correctly diagnosed and promptly treated.

Functional anatomy

The anatomy of the hip and groin is complex. In addition to numerous muscles and tendons, there are also glands, bursae, and other soft tissue areas that can be inflamed and involved in the injuries.
The bones are the pelvic and the hip bones, the sacrum, and the coccyx. There is little movement across the joints of the pelvis and no muscles act on these joints. The pelvis serves as a weightbearing connection between the lower extremities and the trunk. The hip joint is very stable. The force transmitted across the force to 5 times body weight during the stance phase and 3 times body weight during the swing phase.